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Scaling up MedRec Measurement – Experiences from Alberta

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Canadian Patient Safety Institute
Canadian Patient Safety Institute

Purpose of the Call: •Speakers from AHS will share: •AHS’ approach to measurement for improvement (MedRec) •Lessons learned throughout our measurement journey •Their approach to using data to drive change at the frontline

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www.saferhealthcarenow.ca Scaling up MedRec Measurement – Experiences from Alberta November 2014
www.saferhealthcarenow.ca MedRec Quality Audit Month 2015 Throughout February 2015 we are encouraging all acute and long term care sites to participate in MedRec Quality Audit Month to evaluate the quality of their established admission MedRec processes. Register to participate at www.saferhealthcarenow.ca! 2
www.saferhealthcarenow.ca www.ismp-canada.org Doc Mike Evans discusses the importance of keeping a medication list http://youtu.be/f2KCWMnXSt8
www.saferhealthcarenow.ca www.ismp-canada.org MedRec Stay Informed and Connected Receive ISMP Canada’s MedRec Newsletter Hear about: – Upcoming MedRec webinars – New toolkits – National MedRec Audit Month – New MedRec publications – MedRec related workshops Join Now! visit http://www.ismp-canada.org/register/medrec.php
www.saferhealthcarenow.ca Describe your level of activity with MedRec auditing in your setting ce P oll Just Getting Making None Started Progress Almost Fully there Implemented 5 Click on the arrow icon and then click on the appropriate location/response on the slide
Scaling up MedRec Measurement - Experiences from Alberta Greg Duchscherer, RRT, BHS, PMP Project Manager, Provincial Medication Reconciliation Lynn Whitten, RN, BN, MSA Project Manager, Calgary Zone Medication Reconciliation Team Alim Amershi, DipMM, B.Comm Project Coordinator, Calgary Zone Medication Reconciliation Team
7 Alberta Health Services Albertans = 3.9 Million (661,848 km2) AHS Employees = 96,000 Physicians = 8,400 Sites = 450 Five Zones and Cancer Control In 2012-2013: 2,116,474 Emergency Department Visits 8,230 Acute Care hospital beds 108,855 Home Care clients 22,533 Continuing Care beds
8 Objectives •Overview of MedRec Implementation in AHS •Approach to Evaluation of Medrec in AHS •Results so far… •Lessons Learned •Next Steps
9 •Major Patient Safety Initiative •Accreditation Canada Required Organizational Practice (ROP) •Varied Past: –Multiple approaches •Desired Future: –Coordinated, integrated approach History of MedRec in AHS
10 Approach & Zone Implementation Ambulatory Care settings 2014 - 2015 Discharge / Transfer 2014 Admission Acute Care/ Homecare & LTC 2011 - 2013 Provincial Planning 2011- 2015 North Zone Implementation Edmonton Zone Implementation Central Zone Implementation Calgary Zone Implementation South Zone Implementation Provincial MedRec Planning Phased in Approach “Viral Spread” model
11 Our Goal •To have MedRec completed on all patients (where appropriate) across the AHS continuum by the end of 2015.
12 “Seeing the Issue”
13 Measurement for Improvement •How will we know a change is an improvement? •“Measurement is only a handmaiden to improvement, but improvement cannot act without it” •“Measurement for the purposes of learning not judgment” •“Remember, measurement is a means for answering questions. It is not an end in itself”
14 Approach to Evaluation of MedRec Success Measure (target 80%, goal 100%) –% patients with MedRec Completed on Admission (Acute Care, LTC & Corrections) Quality Measure (target 80% of patient audit sample have all quality elements) –Two or more sources for BPMH –Actual med use verified by patient/family –Complete medication information –Every med accounted for in orders –Rationale included for hold and discontinued meds Outcome Measure (target less than 10%, goal 0) –% patients with one or more outstanding discrepancies
15 Acute Care – Measures
16 Acute Care – Quality Elements
17 Zone Acute Care – Measures
18 Reporting & Learning System Data
19 Reporting & Learning System Data
20 Lessons Learned - Provincial •Limitations of data representation •Not having a ‘pure’ patient outcome measure •Subjectivity of Measure 5 •Inter-rater reliability: –Evidence from PSM data –Link to education and ongoing training •Digestible data to managers •Support for QI at the “bedside”
Calgary Zone Experience Lynn Whitten, RN, BN, MSA Project Manager, Calgary Zone Medication Reconciliation Team Alim Amershi, DipMM, B.Comm Project Coordinator, Calgary Zone Medication Reconciliation Team
22 Calgary Zone Project Team  Project Manager  Project Coordinators  Physician Lead  Pharmacy consultant  Administrative Support
23 Calgary Zone Map
24 Our Approach in the Zone Key Areas Of Focus •Engagement Strategies •Use of Objective Data
25 Governance Committee Structure
26 Early Adopters
27 Site/Program Lead Model •Influential, well known and respected early adopters •Regular monthly reporting requirements –% of uptake by individual units & programs •Each site responsible to conduct their monthly audits - site determined who would conduct audits - monitor audit submissions - use raw data from PSM to develop site & service reports
28 Results so far...
29 Progress Reports
30 Site/Program Service Comparisons from PSM
31 Hospitalists Measurement September - October
32 Surgery
33 Lessons Learned •Persistence, persistence, persistence…. •Focus on local culture: it’s a team effort, different process in different units •Look for common goals  Improved Patient Care! •Metrics helps drive the change •Internal competition helps •Break down process into parts to identify gaps and areas for improvement •Identify gaps BUT celebrate successes!!
34 Next Steps – Calgary Zone •Focus on Ambulatory Care •Sustainability •Share learning's •Teams must have access to data for improvement •Developing solutions to address gaps.
35 Next Steps - Provincial •Homecare and Supportive Living Audit Tool •Discharge Audit Tool •Ambulatory Care Audit Tool •Emergency Department/Urgent Care Audit Tool •Transfer Audit Tool •Database and Reporting Dashboard for AHS •Auditor Education and resources
36 Conclusion
37 Thank You
www.saferhealthcarenow.ca Upcoming MedRec Webinars 38 Thank you for attending Our next MedRec webinar will take place in January 6th, 2015. Topic: MedRec Quality Audit Month Information call.
www.saferhealthcarenow.ca Safer Healthcare Now! website http://www.saferhealthcarenow.ca/EN/events/ NationalCalls/2014Webinars/Pages/default.aspx ISMP Canada website http://www.ismp-canada.org/medrec/#webinars Safer Healthcare Now! MedRec Community of Practice http://tools.patientsafetyinstitute.ca/Communities /MedRec/default.aspx For real time notification of content posting, “like” the Medication Reconciliation Network on Facebook www.facebook.com/MedicationReconciliation All Safer Healthcare Now! webinars are posted within the week to the following locations:
www.saferhealthcarenow.ca www.ismp-canada.org 40 We encourage you to report medication incidents Practitioner Reporting https://www.ismp-canada.org/err_report.htm Consumer Reporting www.safemedicationuse.ca/

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Scaling up MedRec Measurement – Experiences from Alberta

  • 1. www.saferhealthcarenow.ca Scaling up MedRec Measurement – Experiences from Alberta November 2014
  • 2. www.saferhealthcarenow.ca MedRec Quality Audit Month 2015 Throughout February 2015 we are encouraging all acute and long term care sites to participate in MedRec Quality Audit Month to evaluate the quality of their established admission MedRec processes. Register to participate at www.saferhealthcarenow.ca! 2
  • 3. www.saferhealthcarenow.ca www.ismp-canada.org Doc Mike Evans discusses the importance of keeping a medication list http://youtu.be/f2KCWMnXSt8
  • 4. www.saferhealthcarenow.ca www.ismp-canada.org MedRec Stay Informed and Connected Receive ISMP Canada’s MedRec Newsletter Hear about: – Upcoming MedRec webinars – New toolkits – National MedRec Audit Month – New MedRec publications – MedRec related workshops Join Now! visit http://www.ismp-canada.org/register/medrec.php
  • 5. www.saferhealthcarenow.ca Describe your level of activity with MedRec auditing in your setting ce P oll Just Getting Making None Started Progress Almost Fully there Implemented 5 Click on the arrow icon and then click on the appropriate location/response on the slide
  • 6. Scaling up MedRec Measurement - Experiences from Alberta Greg Duchscherer, RRT, BHS, PMP Project Manager, Provincial Medication Reconciliation Lynn Whitten, RN, BN, MSA Project Manager, Calgary Zone Medication Reconciliation Team Alim Amershi, DipMM, B.Comm Project Coordinator, Calgary Zone Medication Reconciliation Team
  • 7. 7 Alberta Health Services Albertans = 3.9 Million (661,848 km2) AHS Employees = 96,000 Physicians = 8,400 Sites = 450 Five Zones and Cancer Control In 2012-2013: 2,116,474 Emergency Department Visits 8,230 Acute Care hospital beds 108,855 Home Care clients 22,533 Continuing Care beds
  • 8. 8 Objectives •Overview of MedRec Implementation in AHS •Approach to Evaluation of Medrec in AHS •Results so far… •Lessons Learned •Next Steps
  • 9. 9 •Major Patient Safety Initiative •Accreditation Canada Required Organizational Practice (ROP) •Varied Past: –Multiple approaches •Desired Future: –Coordinated, integrated approach History of MedRec in AHS
  • 10. 10 Approach & Zone Implementation Ambulatory Care settings 2014 - 2015 Discharge / Transfer 2014 Admission Acute Care/ Homecare & LTC 2011 - 2013 Provincial Planning 2011- 2015 North Zone Implementation Edmonton Zone Implementation Central Zone Implementation Calgary Zone Implementation South Zone Implementation Provincial MedRec Planning Phased in Approach “Viral Spread” model
  • 11. 11 Our Goal •To have MedRec completed on all patients (where appropriate) across the AHS continuum by the end of 2015.
  • 12. 12 “Seeing the Issue”
  • 13. 13 Measurement for Improvement •How will we know a change is an improvement? •“Measurement is only a handmaiden to improvement, but improvement cannot act without it” •“Measurement for the purposes of learning not judgment” •“Remember, measurement is a means for answering questions. It is not an end in itself”
  • 14. 14 Approach to Evaluation of MedRec Success Measure (target 80%, goal 100%) –% patients with MedRec Completed on Admission (Acute Care, LTC & Corrections) Quality Measure (target 80% of patient audit sample have all quality elements) –Two or more sources for BPMH –Actual med use verified by patient/family –Complete medication information –Every med accounted for in orders –Rationale included for hold and discontinued meds Outcome Measure (target less than 10%, goal 0) –% patients with one or more outstanding discrepancies
  • 15. 15 Acute Care – Measures
  • 16. 16 Acute Care – Quality Elements
  • 17. 17 Zone Acute Care – Measures
  • 18. 18 Reporting & Learning System Data
  • 19. 19 Reporting & Learning System Data
  • 20. 20 Lessons Learned - Provincial •Limitations of data representation •Not having a ‘pure’ patient outcome measure •Subjectivity of Measure 5 •Inter-rater reliability: –Evidence from PSM data –Link to education and ongoing training •Digestible data to managers •Support for QI at the “bedside”
  • 21. Calgary Zone Experience Lynn Whitten, RN, BN, MSA Project Manager, Calgary Zone Medication Reconciliation Team Alim Amershi, DipMM, B.Comm Project Coordinator, Calgary Zone Medication Reconciliation Team
  • 22. 22 Calgary Zone Project Team  Project Manager  Project Coordinators  Physician Lead  Pharmacy consultant  Administrative Support
  • 24. 24 Our Approach in the Zone Key Areas Of Focus •Engagement Strategies •Use of Objective Data
  • 27. 27 Site/Program Lead Model •Influential, well known and respected early adopters •Regular monthly reporting requirements –% of uptake by individual units & programs •Each site responsible to conduct their monthly audits - site determined who would conduct audits - monitor audit submissions - use raw data from PSM to develop site & service reports
  • 28. 28 Results so far...
  • 30. 30 Site/Program Service Comparisons from PSM
  • 31. 31 Hospitalists Measurement September - October
  • 33. 33 Lessons Learned •Persistence, persistence, persistence…. •Focus on local culture: it’s a team effort, different process in different units •Look for common goals  Improved Patient Care! •Metrics helps drive the change •Internal competition helps •Break down process into parts to identify gaps and areas for improvement •Identify gaps BUT celebrate successes!!
  • 34. 34 Next Steps – Calgary Zone •Focus on Ambulatory Care •Sustainability •Share learning's •Teams must have access to data for improvement •Developing solutions to address gaps.
  • 35. 35 Next Steps - Provincial •Homecare and Supportive Living Audit Tool •Discharge Audit Tool •Ambulatory Care Audit Tool •Emergency Department/Urgent Care Audit Tool •Transfer Audit Tool •Database and Reporting Dashboard for AHS •Auditor Education and resources
  • 38. www.saferhealthcarenow.ca Upcoming MedRec Webinars 38 Thank you for attending Our next MedRec webinar will take place in January 6th, 2015. Topic: MedRec Quality Audit Month Information call.
  • 39. www.saferhealthcarenow.ca Safer Healthcare Now! website http://www.saferhealthcarenow.ca/EN/events/ NationalCalls/2014Webinars/Pages/default.aspx ISMP Canada website http://www.ismp-canada.org/medrec/#webinars Safer Healthcare Now! MedRec Community of Practice http://tools.patientsafetyinstitute.ca/Communities /MedRec/default.aspx For real time notification of content posting, “like” the Medication Reconciliation Network on Facebook www.facebook.com/MedicationReconciliation All Safer Healthcare Now! webinars are posted within the week to the following locations:
  • 40. www.saferhealthcarenow.ca www.ismp-canada.org 40 We encourage you to report medication incidents Practitioner Reporting https://www.ismp-canada.org/err_report.htm Consumer Reporting www.safemedicationuse.ca/